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Antibiotic prescription policy for acute otitis media: do we follow the guidelines?
Tal Marom1,2, Galit Shefer3, Sagi Tshori3,4
1Central District, Clalit Health Services, Tel Aviv-Yafo, Israel.
Background:
Acute otitis media (AOM) is a common cause for antibiotic prescription. Most guidelines endorse abstaining from immediate antibiotic treatment ('watchful waiting', WW) in mild-moderate episodes. We studied adherence rates to the latest AOM guidelines (2013), in terms of antibiotic type and prescription options.
Methods:
In this population-based study, AOM episodes were identified in Clalit Health Services-insured children aged 0-10 years between 2011 and 2018, using a data-sharing platform. After identifying the index, prescription and issuing dates for antibiotics for each AOM episode, treatment was categorized as immediate (≤2 days after diagnosis) or WW (antibiotic not prescribed/issued; prescribed ≤2 days after diagnosis but issued on Days 2-7; or prescribed/issued on Days 2-7). Guideline adherence was measured according to age.
Results:
Of the 491 106 episodes, 361 518 (73.6%) were treated with antibiotics. Following the 2013 guidelines, the ratio of episodes in children aged ≤6 months that were adherent (immediate treatment) was higher (OR = 1.22; 95% CI 1.15-1.29; P < 0.001), whereas the adherent episode ratio for children aged 6-24 months and 2-10 years (WW) was lower (OR = 0.87; 95% CI 0.85-0.88 and OR = 0.94; 95% CI 0.92-0.96, respectively; P < 0.001). Antibiotic prescription rates after 2013 for children aged ≤6 months were not different (OR = 1.03; 95% CI 0.96-1.1; P = 0.4), but were higher in children aged 6-24 months and 2-10 years (OR = 1.07; 95% CI 1.05-1.09; P < 0.001 and OR = 1.02; 95% CI 1.01-1.04; P = 0.015, respectively). Amoxicillin was the most common antibiotic, administered in 75.6% of episodes. Azithromycin was most commonly associated with treatment failure (6.6%).
Conclusions:
Improved adherence to the 2013 guidelines was observed only in children aged ≤6 months and over-treatment with antibiotics was still high.
Insights
Adherence to acute otitis media guidelines improved for infants under 6 months, but antibiotic over-treatment remains high in children. Watchful waiting (WW) adherence decreased in older children, indicating a need for better guideline implementation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Acute otitis media (AOM) is a frequent reason for antibiotic prescriptions in children.
- Current guidelines recommend watchful waiting (WW) for mild-to-moderate AOM episodes to reduce antibiotic overuse.
- Assessing adherence to these guidelines is crucial for optimizing pediatric care.
Purpose of the Study:
- To evaluate adherence to the 2013 acute otitis media (AOM) treatment guidelines in a pediatric population.
- To analyze antibiotic prescribing patterns and watchful waiting (WW) rates based on age groups.
- To identify trends in antibiotic use and treatment outcomes following guideline implementation.
Main Methods:
- A population-based study analyzed AOM episodes in children aged 0-10 years between 2011 and 2018.
- Treatment was categorized as immediate or watchful waiting (WW) based on antibiotic prescription and issuance dates.
- Guideline adherence was assessed by comparing actual treatment patterns against 2013 guideline recommendations for different age groups.
Main Results:
- Over 73% of 491,106 AOM episodes received antibiotic treatment.
- Adherence to immediate treatment guidelines was higher in infants ≤6 months (OR=1.22), while WW adherence decreased in children aged 6-24 months (OR=0.87) and 2-10 years (OR=0.94).
- Antibiotic prescription rates increased for children aged 6-24 months and 2-10 years post-guidelines, with amoxicillin being the most common antibiotic.
Conclusions:
- Guideline adherence improved only for infants under 6 months.
- Over-treatment with antibiotics remains a significant issue in pediatric AOM management.
- Further strategies are needed to enhance guideline implementation and reduce unnecessary antibiotic prescriptions in older children.
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